PPIUCD Programme.pptx

Post partum IUCD programme details .

1. PPIUCD Programme Dr Dhwani Desai Asso.Professor Obs & Gynec Dept. GMCS

2. Reference Postpartum IUCD Reference Manual November, 2010 Family Planning Division Ministry of Health and Family Welfare Government of India

3. Women are highly motivated and receptive to accept Family Planning (FP) methods during the postpartum period. 40 percent of women in the first year postpartum intend to use a family planning. Institutional deliveries strengthen maternal and child health (MCH) and FP services

4. Rationale for Postpartum Family Planning 1. Maternal and Child Health 2. Unmet need for birth spacing 3. Return of fertility

5. Healthy Spacing of Pregnancy Approximately 27% of births in India occur in less than 24 months after a previous birth. Another 34% of births occur between 24 and 35 months. 61% of births in India occur at intervals that are shorter than the recommended birth-to-birth interval of approximately 36 months.

6. POSTPARTUM IUCD Background

7. Policy The CuT-380A is approved for immediate postpartum insertion as a method of contraception.  The PPIUCD must only be placed after the woman is counseled and gives informed consent. Counseling should take place in the antenatal period, in early labor or immediately postpartum. Counseling for informed consent should not take place during the active phase of labor.

8. The PPIUCD can be placed immediately following delivery of the placenta, during cesarean section or within 48 hours following childbirth. The IUCD must be inserted only by a service provider who has been trained to competency in Immediate PPIUCD service provision according to national standards. PPIUCD insertion must be done in a healthcare facility that provides delivery services and has acceptable standards of infection prevention.

9. The following standards of care must be maintained. Woman must be counseled regarding advantages, limitations, effectiveness, side effects and problems related to IUCD. 2. The provider must explain the procedure for insertion and/or removal of the immediate PPIUCD. 3. Woman must be screened for clinical situations as per WHO Medical Eligibility Criteria (MEC). Screening should take place in the antenatal period, as well as immediately prior to insertion, immediate postpartum.

10. 4. The woman must be counseled and offered another suitable postpartum family planning method if her clinical situation does not allow for insertion of the immediate PPIUCD. 5. The provider must insert the IUCD by following all recommended clinical and infection prevention measures for successful insertion.

11. 6. Insertion must be done using a long instrument, such as a placental forceps, to ensure that the IUCD is placed at the fundus. 7. The provider must maintain records regarding PPIUCD insertions and services as per protocol. 8. Woman must be followed up by a provider oriented to PPIUCD services.

12. Timing of insertion The usual timings are: Immediate Postpartum: Postplacental : Insertion within 10 minutes after expulsion of the placenta following a vaginal delivery on the same delivery table. Intracesarean : Insertion that takes place during a cesarean delivery, after removal of the placenta and before closure of the uterine incision. Within 48 hours after delivery: Insertion within 48 hours of delivery and prior to discharge from the postpartum ward. ● Postabortion : Insertion following an abortion, if there is no infection, bleeding or any other contraindications. ● Extended Postpartum/Interval: Insertion any time after 6 weeks postpartum.

13. There are 2 types of IUCDs available in India – Copper-bearing IUCDs, made of a small inert plastic frame covered with copper sleeves and/or copper wire Progestin-releasing IUCDs which continuously release a small amount of levonorgestrel . Among the copper-bearing IUCDs, the CuT-380A is available in the government program and it is used for immediate postpartum insertion. Cu-375 (popular commercial name Multi Load) has been approved for use in the private sector, with planned introduction into the government program (Refer IUCD Reference Manual, Ministry of Health and Family Welfare, Government of India 2006 for details.)

14. Mode of action The IUCD interferes with the ability of sperm to survive and to ascend the fallopian tubes where fertilization occurs. It alters or inhibits sperm migration, ovum transport and fertilization. It stimulates a sterile foreign body reaction in endometrium potentiated by copper.

15. Effectiveness The CuT-380A is a highly effective (>99% effective). There are 0.6 to 0.8 pregnancies per 100 women in first year of use. The CuT-380A is effective for 10 years of continuous use. It can, however, be used for whatever time period the woman wants, up to 10 years.

16. Advantages for the woman: Convenience; saves time and additional visit. Safe because it is certain that she is not pregnant at the time of insertion. High motivation (woman and family) for a reliable birth spacing method. Has no risk of uterine perforation because of the thick wall of the uterus. Reduced perception of initial side effects (bleeding and cramping). Reduced chance of heavy bleeding, especially among lactational amenorrhea method (LAM) users, since they are experiencing amenorrhea. No effect on amount or quality of breast milk. The woman has an effective method for contraception before discharge from hospital.

17. Advantages for the service provider or the service delivery site: Certainty that the woman is not pregnant. Saves time as performed on the same delivery table for postplacental / intracesarean insertions. Additional evaluations and separate clinical procedure is not required. Need for minimal additional instruments, supplies and equipment. Convenience for clinical staff; helps relieve overcrowded outpatient facilities thus allowing more women to be served.

18. Specific limitations Increased risk of spontaneous expulsion. The skilled clinicians with right technique of insertion are associated with lower expulsion rates. Perforation of the uterus while placing a PPIUCD immediately after delivery of placenta or during cesarean section or during the first 48 hours postpartum is unlikely because of the thickness of the uterine wall in the postpartum period. No such cases are reported in the literature. The other limitations of the immediate PPIUCD are the same as the interval IUCD.

19. Postpartum family planning counseling Post Insertion Counseling Follow-Up Care and Counseling

20. medical eligibility criteria for the immediate PPIUCD services Category 1: Immediate postplacental , immediate postpartum six weeks postpartum Category 2: no conditions Category 3: Between 48 hours and six weeks postpartum , Chorioamnionitis ,Prolonged rupture of membranes (ROM)> 18 hours Category 4: Puerperal sepsis ,Unresolved postpartum haemorrhage

21. Technique of insertion

22. MANAGEMENT OF POTENTIAL PROBLEMS 1. Client Discomfort or pain 2. Displacement of the IUCD 3. Cervical Laceration 4. Uterine Perforation

23. 1. Changes in Menstrual Bleeding Patterns 2. Cramping or Pain 3.Infection 4. IUCD String Problems 6. Pregnancy with an IUCD in Place

24. FOLLOW-UP CARE

25. Thanks….